L25: Anatomy of thyroid gland and neck cancers Flashcards
Where are the major tumour sub sites in the head and neck?
- lip/oral cavity
- pharynx (oropharynx: C1/nasopharynx: C2-C3/hypopharynx: C4-C6)
- larynx (supraglottis/glottis/subglottis)
- thyroid
- nasal cavity/sinuses
- major salivary glands
What do you do to visualise the vocal cords?
Stroboscopy (light)
What are the risk factors for head and neck cancers?
Head and neck:
- smoking
- alcohol
- dental hygiene
- betal nut chewing
- viruses (HPV in oropharynx)
- premalignancies (leucoplakia/erythroplakia)
Thyroid specifically
- irradiation exposure (radioactive iodine)
- family history of inherited conditions
- young/old lumps in thyroid glands are more likely to be malignant (more common in women)
What are the general principles of head and neck cancer management?
Support with: swallowing, feeding, voie rehab, pain
Medical: radiotherapy/chemotherapy
Surgical: assessment of tumour/biopsy/remove/reconstruct
(MDT approach)
How does a lip/oral cavity tumour present?
- lump
- pain (included referred to the ear- nerves)
- fixation of tongue, sometimes difficulty with speech
- dysphagia (problems swallowing)
- odynophagia (pain on swallowing)
How do you investigate a lip/oral cavity tumour?
- biopsy
- may need imaging with CT (not needed for superficial lip lesions) +/-MRI
- may need PET (radioactive uptake of glucose)
How do you treat lip/oral cavity tumours?
- small tumours: excise and repair the defect (common)
- radiotherapy
- larger tumours that don’t respond to radiotherapy may need extensive surgery (hemiglossectomy/total glossectomy)
How do pharynx tumours present?
- lump
- pain (including referred pain otalgia)
- dysphagia
- odynophagia
- weight loss
How do you investigate pharynx tumours?
- imaging with CT +/- MRI
- may need PET
- biopsy
- often need feeding assistance with gastrostomy tube
How do you treat pharynx tumours?
- small tumours excise and repair the defect (robotic resection)
- radiotherapy
- larger tumours that don’t respond to radiotherapy may need extensive surgery (mandibular split/pharyngectomy)
How you tumours in the larynx present?
- dysphonia (voice change-main feature)
- dysphagia
- referred otalgia
- glogus (feeling of neck lump)
- neck lump
- weight loss
- cacexia (weakness and wasting of the body)
How do we investigate tumours in the larynx?
- imaging with CT +/- MRI
- may need PET
- biopsy
- often have long term voice issues +/- swallowing problems
How do we treat laryngeal cancers?
- small tumours may have laser resection/radiotherapy
- medium sized tumours treated with radiotherapy/chemotherapy
- larger tumours that don’t respond to radiotherapy may need extensive surgery (laryngectomy-results in hole in neck out of which the patient breathes)
What is a tracheostomy?
Hole into windpipe: not permanent
How does thyroid cancer present?
- lump (in thyroid/neck nodal metastases)
- compressive symptoms: problems swallowing, feel like being strangled
- can have voice change
